Medicare Too Busy For Fraud

LETTERS TO THE EDITOR

March 9, 1999

Many times I have responded in my mind to an article appearing in your newspaper, but then got busy with other things, and failed to reduce my concern or interest, to writing. However, your recent editorial, "Patients could offer vital help in finding, halting Medicare fraud," prompted me to respond immediately.

How powerful patient cooperation in reporting fraud, excesses and errors might be if Medicare had an interest in using such information to contain costs, but I do not think that is the case. I have been taking care of my dear mother's Medicare matters for some time, and have had occasion to bring to the attention of Medicare the kind of information your article indicates would be beneficial. Much to my surprise (initially, anyway), Medicare expressed no interest in such reporting. As an example, my mother was admitted as an out-patient for a needle biopsy of her pancreas. The bill showed that mother was being charged for a "pacemaker." I called the hospital to report the "error," and was told by the billing department that they would check to see "if it was an error." I assured the hospital that my mother, indeed, had not been given a pacemaker. I rushed to report this matter to Medicare, expecting that they would be as appalled as I was, and that they would immediately contact the hospital to have the erroneous charge removed. Instead, I was told that Medicare does not have the time to audit every single bill, and had to rely on "random auditing." The fact that an audit was not necessary meant nothing, and the clerk reiterated that Medicare had to rely on random audits. I followed through, and spoke to many supervisors, until I made contact with someone who assured me that the matter would be corrected. My feeling is that the correction took place because I refused to be dismissed -- not because Medicare had an interest. Your article makes perfect sense, unless you have attempted to do what it suggests. Thanks for the good thoughts.